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FLORIDA HEALTH CARE PLANS VOLUME 27 ISSUE 3 SUMMER 2021
FLORIDA HEALTH CARE PLANS
FOR PROVIDERS
FLORIDA HEALTH CARE PLANS VOLUME 27 ISSUE 3 SUMMER 2021
Back to School Wellness
Exams
Dr. Brinkerhoff explains how
to get your patients starting
the new school year on the
4
right foot!
Florida Health Care
Plans will be Closed:
• Monday, July 5th—
In observance of
Independence Day
• Monday, September 6th—
Labor Day
Case Management Coordination
of Care Programs
Our CMCOC Programs are member
and family-centered, team-based
services designed to assess
and meet the needs of
members. 6 2
FLORIDA HEALTH CARE PLANS VOLUME 27 ISSUE 3 SUMMER 2021
JULY IS UV SAFETY MONTH
“Anyone working outdoors is exposed to the sun’s ultraviolet (UV) rays,
even on cloudy days. UV rays are a part of sunlight that is an invisible
form of radiation. There are three types of UV rays. UVA is believed to
damage connective tissue and increase the risk for developing skin
cancer. UVB penetrates less deeply into the skin, but can still cause some
types of skin cancer. Natural UVC is absorbed by the atmosphere and
does not pose a risk.”
Click Here to access the full “Fast Facts—Protecting Yourself
from Sun Exposure” PDF
NEED HEALTH INSURANCE
YOUR COMPANY CAN TRUST
& AFFORD…
Did you know that FHCP offers comprehensive
health insurance for employer groups of all sizes?
With FHCP, you can count on quality and
affordability with a personal, local touch! For
more information click here.
Please contact Mary Lou Blackmer at
mblackmer@fhcp.com or Haylie Allegra at
Hallegra@fhcp.com to learn more.
3
FLORIDA HEALTH CARE PLANS VOLUME 27 ISSUE 3 SUMMER 2021
How to get your
patients starting the
new school year on
the right foot!
These visits provide additional benefits to
children regularly following up with their primary
care provider. Maintaining a relationship with a
child/children’s provider with intermittent acute
concerns as they arise is vital, but it’s also
important to have time to discuss
preventive strategies to keep children
healthy.
Early in a child’s life, providers closely
With this school year ending, it is important
follow growth and development. Ensuring
to encourage scheduling children and they are meeting proper milestones and
adolescents for their wellness exams prior coordinating care and follow up for those
to the upcoming school year. Typically, we who are not. Healthy diet and activity
think of back-to-school physicals as an screenings are performed with discussion
of recommendations and/or suggestions
opportunity to evaluate if a child is healthy
for how to help families get their picky
enough to participate in physical activities
eaters more variety in their diets. As a
and extracurricular sports. Most parents child matures, we ensure they have
also know this is the time children get healthy BMI and blood pressure
caught up on their vaccinations as well. measurements on annual screening.
Continued on next page.
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FLORIDA HEALTH CARE PLANS VOLUME 27 ISSUE 3 SUMMER 2021
Additionally, hearing and vision screening are important
elements of the well child check. Inadequate screening and
subsequent treatment can leave a child to fall behind their peers
academically. Promoting adequate dental hygiene is often a
talking point as well as ensuring routine dental visits. Children
often are getting more than the recommended of 1-2 hours of
“Screen time” and this can be an opportunity for discussion as
well.
Providers should inquire about social, behavioral, and emotional concerns at
home, school, and with peers. This looks differently throughout the span of
childhood but often includes screening for bullying and discussion of their
relationships. Providers also take the opportunity to screen for alcohol, drug,
and tobacco use and provide age-appropriate counseling for patients.
Adolescents and teenagers also should have the chance to meet independently
with their provider to receive evidence based and scientific answers to
questions they may have about their bodies.
Safety concerns are present throughout childhood as accidental injury is the
leading cause of death in children over the age of one. Recommendations
include wearing seatbelts, wearing helmets, swim safety, firearm safety, etc.
Suicide is the second leading cause of death in children age 10-18 and
depression screening, and coordination of care when depression is present, is
an important element of the well adolescent exam.
With so much preventive care packed into one visit, you can see why it is so
important to make that well child check appointment before school starts this
year.
Krista Brinkerhoff, M.D.
Family Medicine
5
FLORIDA HEALTH CARE PLANS VOLUME 27 ISSUE 3 SUMMER 2021
Case Management
Coordination of Care
Case Management Coordination of Care programs are
member and family-centered, team-based services
designed to assess and meet the needs of members,
while helping them navigate effectively and efficiently
through the health care system. Additionally, the case
mangers act as advocates and educators. Members can
rely on their case managers to work in partnership with
their healthcare team and between healthcare settings, to
identify needs, link to available resources, and provide
recommendations of proactive lifestyle practices that will
support health and wellbeing. The Case Management
Criteria for Enrollment in Coordination of Care programs utilize evidence-based
Case Management clinical guidelines to complete a thorough assessment of
Coordination of Care the member’s condition, evaluate available benefits and
resources, develop healthcare goals with the member,
and develop a plan for monitoring and follow up. Case
Criteria for enrollment in Case Management Management is a voluntary program and all eligible
Coordination of Care includes but not limited to members have the right to decline participation.
members with new diagnoses, acute or
uncontrolled chronic diseases, critical events that The Case Manager will determine which services are
require extensive use of resources, significant appropriate to assist the member
barriers of psychosocial/financial concerns (social • Chronic Complex Care- assists members with complex
determinants of health) that limit access to care, and chronic health conditions to reduce disease
or identified from proactive data screening, who progression and gain empowerment through
may require any of the following: improved lifestyle practices that aims to improve
quality of life. Members would benefit from
• Assistance navigating the health care system advocacy, education, and navigation to access
• Assistance with monitoring and treatment appropriate care, link to resources, benefits, or
• Assistance with barriers related to programs. Program includes transplant case
psychosocial/financial concerns management.
• Education on health condition(s) and health • Interactive Health at Home- remote patient
coaching monitoring provides a tablet and equipment such as
• Education supporting practitioner plan of care scale, blood pressure cuff, and pulse oximetry. The
• Coordinate appropriate resources, programs, program targets members who would benefit from
or benefits health sessions, monitoring of members’ vital signs,
and management of symptoms. Reports are provided
• Coordinate measures to improve quality of life to the member’s physician to help enhance the
and disease-specific outcomes treatment plan.
Continued on next page.
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FLORIDA HEALTH CARE PLANS VOLUME 27 ISSUE 3 SUMMER 2021
• Short Term Program- assists members with new onset of
health diagnoses, support when coming home from the
New Member Transition
hospital and skilled nursing facilities, or link members to of Care Program
FHCP and community resources. Members would benefit The goal of the Transition of Care team is to
from frequent contact for monitoring and education to assist new members transitioning into our
understand signs and symptoms important to report to their network of providers, pharmacies, and covered
doctor and lifestyle practices that will support health and medications. The member would benefit from
wellbeing. clinical review of health history and
• In-Home Providers- the RN Case Manager coordinates medications to coordinate care with available
member care with the in-home provider services to assist resources, benefits, and participating providers
homebound members that would benefit from primary care or services to make the transition as seamless
services in the home or transitional care when ability is as possible. The RN Navigator assists existing
limited to attend appointments after discharge home from members that are experiencing a change in
the hospital or skilled nursing rehabilitation facility. The benefits, providers, or services, or moving into
in-home provider services help to reduce need for another county served by FHCP or change of
emergency department, hospitalization, and urgent care by employers that offer FHCP insurance.
providing primary care or transitional care services at home. Members & Providers are informed about
In-Home Providers promote health and wellbeing through available Case Management Programs by:
follow up care and medication management.
• Florida Health Care Plans Website
• Community Resource Program- Community Resource (www.fhcp.com)
Coordinators partners with members and providers/referral • Member or Provider Resource Guide
sources to address the barriers to social and economic
• Quarterly newsletters
factors related to health care needs that effect access to
• Department Brochures
healthcare through use of agencies and community
partners. Community Resource Coordinators complete Members may be referred by:
individualized needs assessments to link members with • Practitioners
appropriate and available resources. • Member or Caregiver
For urgent placement or home safety evaluations, • Discharge Planners
physicians would continue to refer members with urgent • Medical Management Programs
needs to Home Health Skilled Nurse and Medical Social
• Proactive Data Claims Review
Worker or Department of Children and Families. Skilled
• Member Services
Nurse Facility placement continues to be directed to
Utilization Management Department 386-676-7187. The New Member Transition of Care Pro-
gram additional referral sources include:
There are various methods to refer the CM COC • Marketing Agents
Department:
• Employer Groups
Case Managers or Community Resources Coordinator Services:
Telephone Contact: Toll Free 855/205-7293 or 386/238-3284 Transition of Care Program:
Email: cmanagement@fhcp.com
Fax: 386/238-3271 Telephone Contact: Toll Free 855/205-7293 or
Website: www.fhcp.com 386/615-5017
FHCP Providers-Internal: E.H.R. Task Email: toc@fhcp.com
Monday—Friday 8:00 AM to 5:00 PM
7
FLORIDA HEALTH CARE PLANS VOLUME 27 ISSUE 3 SUMMER 2021
Provider Surveys & Practice Changes
PROVIDER The Center for Medicare Services (CMS) requires health
plans to maintain accurate provider directories for their
REMINDERS members. If health plans do not comply, they risk
& ANNOUNCEMENTS regulatory fines. Given these requirements from CMS
and everyone’s desire to increase overall customer
satisfaction, FHCP sends out a quarterly request
asking practitioners to verify their current directory
information and to notify us if there has been any
change in your practice. We appreciate you taking the
time to respond to the survey and ask that you contact
us whenever you have a change related to
practitioners, address, telephone numbers, panel
status, or services offered. You can let us know by
faxing us any such changes to (386) 481-5202 or via
email at FHCPProviderRelations5@fhcp.com.
IS YOUR NPI INFORMATION UP TO DATE?
The Centers for Medicare and Medicaid Services (CMS) utilizes the information, such
as practice address, that appears in your NPI record. We are asking that you check
your NPI at NPPES.CMS.HHS.GOV to ensure that your current practice information is
reflected.
The NPI number is used to identify health care providers in standard transactions such
as health care claims. It is important to keep all information, such as a change of
address, with NPPES current. You're required to update your NPI information, online
or by mail, within 30 days of the effective change.
You can update your NPI profile by one of the following means:
By phone: 1-800-465-3203 (toll free) or 1-800-692-2326 (NPI TTY)
By email at: Customerservice@npienumerator.com
By mail at: NPI Enumerator PO Box 6059 Fargo, ND 58108-6059
https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS10114.pdf
8
FLORIDA HEALTH CARE PLANS VOLUME 27 ISSUE 3 SUMMER 2021
East Coast Bariatrics understands there can
be a stigma regarding mental health. Good
mental health takes work in the same way
good physical health takes work. East Coast
Bariatrics will help patients commit to
habits, practices, and routines that are good
for their overall well-being. The licensed
mental health counselor (LMHC) for East
Coast Bariatrics will guide patients to express
feelings without labeling them as bad or
negative. The counselor will assist patients in
utilizing self-care, improving negative
self-talk, and focus on personal enjoyment.
Each patient at East Coast Bariatrics obtains ATTENTION FHCP PROVIDER
the tools to learn self-worth and improve PORTAL USERS:
overall happiness.
To keep your account active, please
For more information on this program,
please have your patient call (386) 238-3205. login at least every 60 days. If you
We will guide them through every step of the need assistance with a password
progress! reset or a locked account, please
contact Customer Service at
1 (877) 814-9909. Thank you for your
understanding and remaining
compliant with Florida Health Care
Plans’ Security Policy.
9
FLORIDA HEALTH CARE PLANS VOLUME 27 ISSUE 3 SUMMER 2021
Scheduling Medicare Wellness exams
for members with contracted physicians: Are you next?
The Medicare benefit of an annual wellness exam is offered in a special program by FHCP for members who
have contracted physicians. A team of health care providers with expertise in gerontological care have
provided this service at contracted physician offices, FHCP facilities, and now through a telehealth
audio-visual interactive visit. The visit expands on a focused wellness exam by giving additional FHCP
service information such as extended care hours clinics, vaccinations, and prevention health screenings
individualized to the member’s needs. Health information is also updated in the electronic medical record
which provides support to FHCP’s diverse medical specialists. Upon completion of the visit, the medical
records department sends the summary report of the visit to the contracted physician. If any screening
tests are ordered for the members at the time of the visit, the member is notified of results and results are
faxed to their physician.
The wellness exam team consists of J. Wes Tanner, MD, who is the Risk Adjustment Medical Director
supervising the preparation of the patient chart recommendations FHCP provides the physicians. His goal is
to provide accurate, concise, and comprehensive data to our contracted physicians to enable better medical
care. When a list of eligible members is received by our program staff, Traci Postell, Medicare Risk
Adjustment (MRA) Service Specialist, calls members to schedule appointments. Traci is the most recent
addition to our team with 20 years’ experience in the health care industry. She explains the value of our
program to members and encourages member participation.
Once the member is scheduled, the telehealth visit is provided by Kay Klymko, PhD, APRN, FNP-BC and
Dorothy (Lynn) Goodrich, LPN, using either Zoom or Doximity software programs. Dr. Klymko and Ms.
Goodrich bring decades of nursing and
gerontological expertise to our program.
Dr. Klymko, received her doctorate in
nursing and was a fellow in the National
Institute of Aging Doctoral training
program through the Institute of
Gerontology, Wayne State University in
Detroit, Michigan. Ms. Goodrich, as a
life-long resident of Volusia County, is
devoted to assuring a successful telehealth
experience for members in our
community. She provides invaluable
assistance to members in helping with the
telehealth connections and gathering
preventative health information.
Continued on next page.
10FLORIDA HEALTH CARE PLANS VOLUME 27 ISSUE 3 SUMMER 2021
As a reminder of this valuable service we offer to your patients, we look forward to meeting with you during
the months of July through September. Our outreach to the following contracted physicians chosen from
West and East Volusia County locations included Deland, Orange City, Deltona, DeBary, Ormond Beach, and
Daytona Beach. Participants include Advent Health Medical Group at Deland, West Volusia Family and
Sports Medicine, Dr. Hina Azmat, Dr. Jay Chanmugam, Dr. Michael DeSouza, Dr. Carlos Dominguez, Family
Health Source, Dr. Magued Ibrahim, Dr. Ananth Krishnan, Dr. Judith Mathura, Dr. Kristina Paradis, Dr.
Andrew Randolph, Saxon Internal Medicine, Dr. Vinny Varghese, Halifax Health PCP Ormond Beach, Dr. John
Chewning, Dr. Savitha Kasturi, Dr. Erica O’Donnell, Ormond Medical Center, Dr. Kashyap Patel, Dr. Vipin
Patel, Dr. Richard Potts, Dr. Evan Carratt, Halifax Health Family and Sports Medicine, and Halifax Health PCP
Daytona Beach.
On occasion members will call their Primary Care office with questions about our program after they are
contacted to schedule an appointment. It is of utmost importance that all office staff reinforce the
important message of the value of this telehealth visit to enable better medical care and communication
between FHCP and our contracted health care providers. We look forward to collaborating with you! If you
have any additional questions about the program, please leave a voicemail message for Kay Klymko at
(386) 676-7100 extension 7687.
IMPORTANT REMINDERS
AND NEW INFORMATION
PROVIDERS AND STAFF, please remember to log in to your Quest Diagnostics
account at least every 90 days to prevent loss of your password. Why not set a
calendar reminder now!
NEW TESTS AVAILABLE!
• 39449 – Metabolic Risk Panel – includes standard lipid panel, ApoB, HbA1c,
Insulin Resistance Panel with Score (Proprietary new test!)
• 39165 – Kidney Profile – Detects and monitors chronic kidney disease (CKD) in
adults.
See the Quest Diagnostic Test Directory at
https://testdirectory.questdiagnostics.com/test/home
for more information and to search any test by name, test code, or CPT code.
FLORIDA HEALTH CARE PLANS, INC. is contracted with Quest Diagnostics for
routine and STAT lab testing and collections. Please note that prior authorization is
required for genetic testing. Check out your Provider Referral Guide for
draw-station locations and more helpful information!
11FLORIDA HEALTH CARE PLANS VOLUME 27 ISSUE 3 SUMMER 2021
National Cholesterol
Education Month
Depending upon several risk categories, a type of
treatment will be recommended by the doctor.
These can include a cholesterol-lowering diet,
changes in levels of physical activity, weight
management, or starting a regiment of medication.
The primary medication for high cholesterol is a class
of drugs called statins. Statins block an enzyme
inside liver cells to disrupt cholesterol production,
thereby reducing the amount being released into the
bloodstream. Some also reduce the inflammatory
September is National Cholesterol Education
process in the vessel wall, stopping plaque formation
Month, and September 29 is World Heart Day.
inside the artery. There are a few other medications
These observances raise awareness about
available, such as resins, selective
cardiovascular disease, cholesterol, and stroke.
cholesterol absorption inhibitors, and lipid-lowering
According to the Centers for Disease Control and therapies such as fibrates, nicotinic acid, and
Prevention (CDC), heart disease is the number one others. Each of these have their own levels of
leading cause of death in the U.S. More than one success and risks for side effects.
million Americans have a heart attack each year
and about 500,000 die of heart disease. High blood Heart health studies have shown that having a pet
cholesterol is one of the major risk factors for heart can help by increasing fitness levels, relieving stress,
disease, causing heart attack and stroke. lowering blood pressure and cholesterol levels,
boosting overall happiness and wellbeing. It’s no
The CDC reported that 71 million American adults surprise that people who walk their dogs are more
have high LDL cholesterol, yet fewer than half get likely to get the recommended amount of physical
treatment, perhaps because they have no activity than those who don’t. Pets also provide
symptoms. For these reasons, the American Heart social support, which is an important factor in
Association recommends all adults age 20 or older helping you stick with new healthy habits.
have their cholesterol checked every four to six
years, and to seek treatment if numbers are out of Sleep could be the key to unlocking better health.
range. Sleep issues, especially not sleeping enough, sleep
apnea and insomnia can increase the risk of obesity,
Risk can be assessed depending on age. Between high blood pressure, Type 2 diabetes, stroke,
20 and 39, lifetime risk may be accessed. If the risk coronary heart disease and overall CVD.
is high or if there is a family history of early CVD
and have an LDL of 160 mg/dL or more, statin Practicing mindfulness and meditation may help your
medications and lifestyle changes to lower your risk patient. Managing stress and high blood pressure is
may be recommended. Between the ages of 40 and part of lifestyle changes. Self-care is an important
75, the American Heart Association has a risk part of overall health. It is vital for monitoring and
calculator called Check. Change. Control. Calculator managing medical conditions as well as preventing
TM https://ccccalculator.ccctracker.com to esti- CVD. Self-care includes the basics of living a healthy
mate 10-year risk of having a heart attack or stroke.
Continued on next page.
12FLORIDA HEALTH CARE PLANS VOLUME 27 ISSUE 3 SUMMER 2021
lifestyle, but also includes more practical things such
as adhering to a drug regimen and paying attention
to new or worsening symptoms. It is estimated that
self-care contributes to 40% of good health.
A treatment plan developed with a health care
professional on an agreed upon plan works best for
our members. For support, encourage the whole
family to join in the heart-healthy lifestyle.
The Florida Health Care Plans Diabetes/Health
Education department offers your patients
education to increase their knowledge, to reduce
cholesterol, and address lifestyle changes. Included
in the program is information about risk factors for
heart disease, healthy eating (such as the DASH and
Mediterranean diets), blood pressure and
cholesterol management, exercise, and stress
reduction. STAY CONNECTED
Referrals can be sent to the department and the
member will be scheduled. Members can also self- There are many outlets to stay
refer by calling the department to schedule an
appointment. There is no charge for FHCP
connected with FHCP! We encourage
members. provider engagement as FHCP utilizes
For more details, please call (386) 676-7133 or toll multiple social media platforms to
free 1-877-229-4518 or email reach it’s audience. So, stay
deducation@fhcp.com
connected!
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